Pharmacological Nursing Notes

Name:___________________________________________________________ Date:___________________

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SITUATION: Mr. Hero Fernando, a 60 year-old bank manager had experienced a sensation of chest tightness, chest pain, sweating and a feeling of apprehension. A diagnosis of CAD with angina pectoris was established The physician orders for nitroglycerin tablet. The nurse knows that the pharmacological action of the drug is: a. To dissolve the atheromatous plaque in the coronary artery b. Constrict the venous vessels and capillaries c. Dilate the coronary arteries d. Decrease the myocardial consumption of oxygen The nurse gave instructions to the patient on nitroglycerin intake. He remarked, “I think I will try not to take too many of these pills.” At this instance, the nurse’s BEST reply would be: a. “I agree, nitroglycerin can cause drug addiction, that is why you must not take too many of the pills” b. “I must inform you that nitroglycerin is non-habituating and you should take the pills many times to relieve the pain” c. “You will be needing only three tablets to ease the pain and if unrelieved, you must seek medical attention” d. “ There is no problem with continuous daily intake because nitroglycerin does not cause a tolerance effect” The nurse must emphasize to the patient which ONE of the following side-effects of nitroglycerin: a. Headache c. Nausea and vomiting b. Hypertension d. Visual changes What other information must the nurse provide to the patient taking the nitroglycerin? a. Keep the tablet in a clear container b. Take the tablet with meals c. Continue to take as many tablets of nitroglycerin until chest pain subsides d. A burning sensation under the tongue is expected The nurse applies the ordered nitroglycerin ointment on the patient’s chest wall. Which nursing action is considered inappropriate? a. The nurse chooses a hairless area b. She spreads the ointment with her fingers c. She removes the ointment on the skin from the previous dose d. She rotates the sites of ointment application The nurse gives which of the following discharge instructions to this patient with angina regarding nitroglycerin therapy? a. Only take the nitroglycerin as desired b. The drug should be taken before engaging in exertional activities c. The tablet should be taken only in the morning d. If the drug does not relieve the pain, increase the frequency of the dose Hero asked the nurse what he could do about his concern about sex activity. The nurse best suggests: a. Tell him to avoid sex for several months while his heart is on therapy b. Suggests that his wife assume the top position c. Tell him to avoid sex on days when he is anxious d. Advise that he should have sex only once a month The nurse understands that her discharge teaching is effective regarding life style modification when the patient says: a. “I know that I will need to eat less, so I will eat once a day only” b. “I will stay on bed most of the time so I wont experience chest pain” c. “I will stop what I’m doing whenever I have pain and take the pill” d. “I need to enroll in a gym class to have a vigorous exercise to condition my heart” SITUATION: Manny is admitted to the medical ward with the diagnosis of essential hypertension. He had hypertensive emergency 2 hours ago and was hospitalized for further observation. The nurse administers prescribed anti-hypertensive meds. If it can be any of the following, she will check the pulse prior to giving: a. Nifedipine b. Metoprolol c. Clonidine d. Captopril

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10. After administering a blood-pressure lowing agent, the nurse must caution the patient: a. To avoid straining during defecation b. To avoid low-sodium and potassium diet c. To avoid abrupt change of positions d. To take warm shower immediately after taking the drug 11. The nurse prepares to give a diet appropriate for a hypertensive patient. Which food should the nurse include in the menu? a. Canned meat loaf b. Scallops and shrimps c. Fresh citrus juice and cake d. Butter and pork steaks 12. If the physician orders Captopril as the home medication for the high BP, the nurse must caution that the side-effect of this drug that is disturbing is: a. Rashes b. Cough c. Pruritus d. Ringing of the ears 13. If the client is discharged with home medication of Propranolol hydrochloride, the nurse must include in her medication-teaching plan which one? a. Take the medication on an empty stomach b. Obtain blood pressure readings regularly c. Perform active exercises to prevent Hypotension d. Caution to avoid hazardous activities after taking the drug 14. The nurse determines that the following drugs are calcium channel blockers that can be prescribed by the physician to the patient. One is not included: a. Nifedipine b. Verapamil c. Telmisartan d. Diltiazem SITUATION: Joseph,, 50 y.o. Businessman awakens in the middle of the night with dyspnea, bilateral basilar rales and frothy sputum. He is brought to the Mulawin hospital. His diagnosis is congestive heart failure. 15. The physician gives the patient furosemide and digoxin. The nurse’s main concern is to: a. Take the central venous pressure reading b. Observe for decrease edema c. Observe for signs and symptoms of hypokalemia d. Force fluids 16. The mechanism of action of dioxin that makes it useful in patients with CHF is that it: a. Produces a negative inotropic effect b. Increases cardiac conduction c. Enhances cardiac contractility d. Increases the heart rate 17. The nurse is very vigilant about digoxin overdose. Which one statement below by the patient may alert the nurse of a possible development of toxicity? a. “Nurse, I don’t feel like eating for the past few days” b. “I am having constipation lately” c. “I am developing a nagging cough and night terrors” d. “I am experiencing dryness of the eyes and sandy sensation” 18. The nurse evaluates that the drug digoxin is effective when the patient manifests: a. Decreased bowel sounds b. Increased urine output c. Increased drowsiness d. Decreased sympathetic response of the body 19. The following manifestations must be assessed by the nurse to detect beginning digitalis toxicity, with the exception of: a. Nausea and vomiting b. Palpitations c. Diplopia and visual yellow-green halos d. Hypertension 20. The nurse instructs the patient on diet modification during digitalis therapy. She is certain that her teaching is effective when the patient will choose all the foods items below, except: a. Fresh orange juice and potato fries b. Dried mangoes and tomato juice

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c. Broccoli salad with bean sprouts d. Flavored gelatin and iced tea 21. The nurse obtains an apical pulse of 78 beats/min. She is bringing the next dose of digoxin and then proceeds to do which one action below? a. Withhold the drug and notify the physician b. Start IV infusion of Digibind (digoxin antibody) c. Instruct patient to consume more meat and nuts d. Administer the drug SITUATION: Armida, an 18-year-old adolescent is seen in the health center because of easy fatigability and frequent dizziness 22. The health center physician determines that she has iron-deficiency anemia. The nurse will anticipate the doctor to order for: a. Bone marrow aspiration b. Hemoglobin level determination c. Platelet count d. BUN and Creatinine 23. A drug is administered to correct anemia, such as an iron. This drug is classified as: a. Antihelminthic b. Anticoagulant c. Hematinic d. Antihistaminic 24. The nurse administers the oral iron tablet. She will give the medication: a. With milk and dairy products b. With antacids to minimize gastric upset c. With fruit juices like calamansi and orange d. With a full glass of coffee or tea 25. The nurse instructs the patient to eat iron-rich foods. She determines that her teaching is effective when the client will choose: a. Pomelo juice and hamburger b. Gelatin and marshmallows c. Lean meat and buttered corn d. Liver and eggyolk 26. The doctor decides to order Iron dextran one ampoule. The nurse prepares to administer the drug: a. Intravenously. Slow IV push b. Intamuscular, Z-track method c. Subcutaneous d. Intrathecal 27. The nurse must warn the patient taking oral iron preparations that it can cause which side effect/s? a. Yellowish discoloration of the skin and mucus membrane b. Darkening of stool color c. Anorexia and loss of hair d. Ulceration of the skin and cough 28. The patient remained pale and weak, upon further examination, it was determined that she has pernicious anemia. The pathophysiology of this hematological disorder is: a. Absence of Vitamin E in the diet b. Presence of excessive iron in the liver c. Absence of intrinsic factor in the stomach d. Temporary bone marrow depression. DRUGS THAT AFFECT THE HEMATOLOGICAL SYSTEM SITUATION: Mrs. Rosalinda Amor, 23 year-old actress is admitted because of a diagnosis of deep vein thrombosis. 29. The nurse employs which of the following non-pharmacological measures in caring for Mrs. Amor? a. Ice compress over the involved leg TID b. Elevate the legs with a pillow c. Maintain on strict bed rest with minimal bathroom privileges d. Massage the involved area 30. The physician orders Heparin sodium for Mrs. Amor. The nurse understands the reason for this therapy is that: a. Heparin will dissolve the clots in the inflamed veins to prevent emobolization b. There is a need to prevent further clot formation in the involved vessels

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c. Heparin will anticoauglate the blood by inhibiting vitamin K metabolism d. The clot formed in the vein must be lysed by activating plasmin, the action of heparin 31. If the doctor orders for heparin therapy monitoring, the nurse must obtain which laboratory tests from the lab unit? a. Prothrombin time b. Clotting time c. Partial thromboplastin time d. Prothrombin consumption test 32. The above laboratory value must is considered therapeutic if the result is about: a. 3 times the normal b. 2 times the normal c. Equals the normal d. Less than the normal 33. The nurse must administer heparin to Mrs. Amor. She determines that the most common routes of administration are: a. IV and IM b. SC and IV c. ID and IM d. IV and intrathecal 34. When the nurse is monitoring the patient for heparin overdose, she is observing for the following signs/symptoms, except? a. Ecchymoses b. Positive Homan’s sign c. Dark, cola-colored urine d. Epistaxis 35. Which one effect of heparin therapy will cause nursing concern? a. Thrombocytopenia b. Constipation c. Bone marrow depression d. Dizziness 36. In the event of an overdose of heparin injection, the nurse prepares which one antidote for toxicity? a. Phytomenadione b. Atropine Sulfate c. Protamine sulfate d. Deferoxamine chelators 37. The doctor switched from standard heparin to low molecular weight heparin injection. The advantage of LMWH over the standard heparin is: a. The LMWH can be administered IM b. The LMWH does not need frequent laboratory monitoring c. The LMWH has a better potency d. The LMWH does not cause bleeding problems 38. The nurse reads the chart and notes for an order of oral Warfarin sodium, while the patient is on heparin therapy. The nurse will: a. Question the order because of potential excessive bleeding if given simultaneously b. Administer the drug as ordered c. Withhold the heparin and administer the Warfarin orally d. Report the error to the nurse supervisor as the patient may be at risk for toxicity 39. IF Mrs. Amor is discharge with warfarin sodium, the nurse must include in her discharge teaching which one? a. Keep Vitamin A ampule available for injection c/o the health center in case of emergency b. Report any bright red blood in the stool or urine c. Take aspirin to manage the headache side-effect of the drug d. Utilize firm toothbrush when brushing to prevent build up of plaques and gingival hyperplasia 40. The nurse must remind the patient that warfarin therapy is monitored with the use of which laboratory examinations? a. PT and PTT b. PT and INR c. Clotting time and bleeding time d. Platelet count and PT

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SITUATION: Mrs. Avery had a previous attack of mild stroke and coronary artery disease. She is taking Aspirin. 41. The reason aspirin is utilized as an anti-platelet medication is because: a. Aspirin can prolong the bleeding time b. Aspirin affects the thromboxane production of the platelet c. Aspirin interferes with the receptor binding of the platelets d. Aspirin blocks the degranulation process inhibiting release of histamine 42. The nurse administers aspirin: a. On an empty stomach to increase absorption b. With meals c. In Between meals d. Intramuscularly 43. Mrs. Avery had a sudden severe and prolonged chest pain. Acute MI is suspected. The nurse anticipates the doctor to order a fibrinolytic, and this may be: a. Tranexamic Acid b. Dipyridamole c. Steptokinase d. Coumadin 44. If the above drug is ordered to be given IV drip, the nurse must be aware of which potential effect? a. Hypersensitivity reaction b. Congestive heart failure c. Further damage to the myocardium d. Excessive clot formation 45. If the patient is receiving tissue-plasminogen activator, the nurse must make which one priority intervention? a. Have heparin sodium available b. Monitor closely the renal status c. Observe for psychotic symptoms d. Obtain a stand by Aminocaproic acid SITUATION: A patient is determined to have hypercholesterolemia and is admitted in the hospital for treatment of her condition. The doctor ordered Lovastatin OD. 46. The nurse determines that the BEST time to give the drug is: a. In the morning before breakfast to promote absorption b. In the afternoon to promote sleep because it is sedating c. At bedtime d. In between meals 47. The nurse is knowledgeable about the mode of action of lovastatin that it: a. It Inhibits the formation of chylomicrons in the intestinal cells b. It prevents the enzyme that synthesizes cholesterol c. It binds with bile acids and cholesterol promoting excretion d. It promotes cholesterol metabolism in the adipose tissue to lower the plasma cholesterol 48. The nurse is prepared to provide comfort measure to the common side effects of the drug. She monitors the patient for: a. Abdominal fullness, flatulence and diarrhea b. Confusion and psychoses c. Palpitations and arrhythmias d. Hypertension and rashes 49. The nurse must monitor for these serious adverse effects of lovastatin. Which one is not included? a. Glaucoma b. Cataract c. Myositis d. Hepatic failure 50. The nurse reads the drug order sheet and is most concern to consult the physician if he orders: a. Paracetamol b. Gemfibrozil c. Vitamin supplements d. Omeprazole 51. The nurse is giving Guaifenesin to a patient. She includes in her teaching which of the following interventions? a. Warn the patient that extreme drowsiness may occur b. Offer a full glass of water

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c. Nausea and vomiting are potential problems alleviated by small frequent meals d. Suggest to buy a nebulizer machine to be used at home e. Vitamin ADEK supplements because of impaired absorption 52. To be able to detect the effectiveness of Salbutamol, the nurse should check for: a. Blood pressure and CVP readings b. Urinary output per hour c. Breath sounds d. Level of consciousness e. Pupillary reflexes 53. The patient is receiving theophylline capsule OD. The nurse cautions the patient to avoid foods with components similar to theophyline and they can be: a. Sugar and cream b. Coffee and chocolate c. Spinach and broccoli d. Beans and aged cheese e. Canned goods and wine 54. The patient is receiving theophylline capsule OD. The nurse cautions the patient to avoid foods with components similar to theophyline and they can be: a. Sugar and cream b. Coffee and chocolate c. Spinach and broccoli d. Beans and aged cheese e. Canned goods and wine 55. The nurse is administering acetylcysteine nebulization to a patient. It is very much important to keep which item below at bedside? a. Scissors b. Ambu bag c. Suction machine d. Tracheostmy set e. NG tube 56. After giving diphenhydramine to the patient, the nurse must ensure that the patient understands the teachings below, EXCEPT: a. Refrain from manipulating delicate machines b. Take sugarless candy in the mouth to relieve dryness c. Avoid taking the drug with alcohol d. Check pulse rate before taking the drug e. Manage gastric upset by taking it with food 57. The nurse watches out for a side-effect associated with intake of codeine sulfate and provides appropriate intervention, this can be: a. Constipation- provide liberal fluids b. Excitement- provide less stimulation c. Tachycardia- administer lidocaine d. Polyuria- give the drug in the morning e. Tachypnea- position on semi-fowler’s 58. Terbutaline sulfate is administered to a patient with asthma. If the patient has another disease, the nurse is most vigilant and cautious if this condition exists: a. Hypothyroidism b. Rheumatoid arthritis c. Diabetes mellitus d. Polycystic ovarian disease e. Emphysema 59. The nurse is administering oxymetazoline nasal decongestant. She includes in her care plan all of the following interventions, EXCEPT? a. Instruct the patient to clear the nasal passage of mucus before instilling b. Remind patient to keep the head tilted for a few seconds after administration c. Advise increased fluid intake d. Encourage the use for one week for better effect e. Caution that tachycardia and urinary retention may occur with systemic absorption 60. The physician asks the nurse for an anticholinergic drug to be used for the asthmatic patient. The nurse obtains from the pharmacy which drug? a. Albuterol b. Terbutaline c. Metaproterenol d. Ipratropium bromide e. Salbutamol

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61. The physician orders dextromethorphan for a patient who is complaining of very uncomfortable coughing. The nurse understands that this drug acts to suppress cough by: a. Increasing the secretions of the bronchial glands b. Removing the irritation from the respiratory tract c. Inhibiting the medulla oblongata cough center d. Inhibiting the stretch receptors in the lungs e. Triggering the vagal responses 62. Inhaled corticosteroid like beclomethasone is administered to the patient with asthma. It is important for the nurse to stress that this drug: a. Acts rapidly to decrease inflammation b. Promotes the secretion of mucus c. May depress the immune function d. Highly effective in terminating acute asthma attack e. Is habituating and addicting 63. The second generation anti-histamines like cetirizine have the advantage over the first generation antihistamines like diphenhydramine because second generation antihistamines: a. Have shorter duration of action that can be reversed rapidly b. Have less sedation and anticholinergic properties c. Posses less drug sensitivity reactions d. Have a greater safety profile e. Have less abuse potential 64. The nurse cautions the patient taking diphenhydramine (Benadryl) to expect all of the following side effects, except? a. Dry mouth b. Blurred vision c. Urinary frequency d. Drowsiness e. Dizziness 65. The nurse must remember to administer theophylline slowly or with an infusion pump because this drug, if given rapidly can cause: a. Increased alertness b. Severe hypotension c. Tachycardia d. Pallor e. Headache

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